Electronic-cigarettes: Clinical solution or pragmatic compromise?

Wendy Preston blogs for Respiratory Futures on the rise and role of e-cigarettes

Tuesday, March 15, 2016

As a Nurse Consultant for Acute Medicine I have many roles and one that I am particularly proud of is being George Eliot Hospital NHS Trust’s BTS Stop Smoking Champion. I lead the Secondary Care Stop Smoking Service that we set up in 2009 and am pleased to say we have now converted to a full ‘smoke free’ site from January 1st this year.

A common question I have is whether electronic cigarettes (EC) should be recommended. This is a difficult one to answer; the evidence indicates that they carry a fraction of the risk of smoking cigarettes but are not risk free. If a person is smoking tobacco then we know that they have at least 50% risk of dying from a smoking related disease, often in middle age.

The evidence-base is still evolving and there is a lot of debate for and against e-cigarettes, but there are some excellent resources available which are being updated as new evidence emerges, including:

It is essential that all patients who see a healthcare professional for whatever reason have smoking and e-cigarette use (‘vaping’) recorded in their medical history as well as their use of any other substances, e.g. cannabis. This information, including length of use, type and any previous ‘quit’ attempts, should be noted alongside any advice or referrals made.

Using electronic cigarettes is around 95% safer than smoking

Some people will have switched to e-cigarettes and stopped using tobacco whilst others may be using an e-cigarette to quit tobacco. Some may be using both tobacco and e-cigarettes depending on the circumstances and this is referred to as ‘dual use’. We should encourage all and especially the ‘quitter’ to accept a referral to local stop smoking services for support to aid their quit. Receiving behavioural support along with their use of e-cigarettes will improve their long-term chances of quitting tobacco.

It is extremely important that all patients are offered referral to a full hospital-based NHS stop smoking service which has capacity to support entire quit attempts (or are referred to community services where more convenient). All options for support should be explained including nicotine replacement therapy, other medication, e.g. varenicline and, I believe, e-cigarettes (in a balanced manner).

It is known there is a small increase in risk of harm from e-cigarettes compared to smoking nothing, however if this route means a person will become tobacco smoke free, it is an excellent clinical compromise. A report commissioned by Public Health England (2015) stated that the current expert estimate that using electronic cigarettes is around 95% safer than smoking. Behaviour support should be offered with all these options too as we know it quadruples success.

Approximately half of hospitals have no access to a stop smoking service and with current public health cuts this lack of provision is likely to rise.

The sad thing is we know approximately half of hospitals have no access to a stop smoking service and with current public health cuts this lack of provision is likely to rise. As Stop Smoking Champions there is urgency for us to push for more resources to protect this frontline treatment.

This year will be the first national BTS Audit on Secondary Care Stop Smoking Provision and we would like all hospitals to take part. We are confident the results will be a big driver for change from a local level to a national perspective.

More information on the Audit, what a Secondary Care Service should look like and how to develop services (including a return on investment tool) are available at: